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To ensure your Credit Representative makes the correct financial product recommendations they must have reasonable grounds for making those recommendations. This means that a Credit Representative must make reasonable inquiries about the consumer’s financial situation, consumer’s requirements and objectives, take reasonable steps to verify the consumer’s financial situation and take reasonable steps prescribed by the regulation to verify all matters relating to this application to ensure the credit contract is not unsuitable for the consumer. We accept no liability for any recommendation given on the basis of inaccurate or incomplete information.

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Your Email Address:

Confirm Email Address:

1. PERSONAL DETAILS

Applicant 1

First Name:

Second Name:

Surname:

Gender:

Date of Birth:

Marital Status:

Dependents:

Ages:

Driver’s Licence:

Expiry:

Applicant 1

Street Address:

Postcode:

State:

Postal Address:

Postcode:

State:

Duration at Residence :

Years :

Home Phone No:

Mobile Phone No:

Bus Phone No :

Applicant 2

First Name:

Second Name:

Surname:

Gender:

Date of Birth:

Marital Status:

Dependents:

Ages:

Driver’s Licence:

Expiry:

Applicant 2

Street Address :

Postcode :

State:

Postal Address :

Postcode :

State:

Months :

Mobile Phone No:

Bus Phone No :

PREVIOUS ADDRESS (IF LESS THAN 3 YEARS IN CURRENT)

Street Address :

Postcode:

State:

Duration at Residence :

Years :

Residential Status :

$ per

own
mortgage
rent
board
employer subsidized

LandlordName :

Street Address :

Postcode :

State:

Month :

Residential Status :

$ per

own
mortgage
rent
board
employer subsidized

Duration of Residence:

Years

Phone:

Page 2

2. Employment Details

Applicant 1

Full Time
Part Time
Casual
Contract
Self Employed
Not Employed

Occupation :

Name of Employer :

Street Address :

Postcode :

State :

Phone No :

Contact Name :

Position/Relationship:

Duration of Employment :

Years
Months

Applicant 2

Full Time
Part Time
Casual
Contract
Self Employed
Not Employed

Occupation :

Name of Employer :

Street Address :

Postcode :

State :

Phone No :

Contact Name :

Position/Relationship:

Duration of Employment:

Years
Months

PREVIOUS EMPLOYMENT (IF LESS THAN 3 YEARS IN CURRENT)

Occupation :

Name of Employer :

Duration of Employment :

Years
Months

Bank / Branch:

References:Finance

References:Personal

Accountant:

Occupation :

Name of Employer :

Duration of Employment :

Years
Months

Bank / Branch:

References:Business

Nearest Living Relative:

Page 3

3. PURPOSE OF PROPOSAL

Why are you seeking credit :

4. NEW ASSET DETAILS and LOAN STRUCTURE

Supplier :

Phone No :

Salesperson :

Description of Equipment: Year / Make/ Model :

New
Used

Auto
Man

Extras :

Trade :

Purchase Price : $

Loan Term :

Less Cash Deposit : $

Balloon : $

Less Trade : $

Plus Payout on Trade Bank : $

Amount Financed : $

Page 4

ASSETS AND LOANS

Cash(personal)

$

Cash(Business)

$

Term Deposits

$

Shares

$

Managed Funds

$

Furniture/Personal Effects(i.e. Contents Insurance)

$

Superannuation

$

STATEMENT OF POSITION

PROPERTY

Address

Value

Bank

Payments

Balance$

CAR,BOATS,CARAVANS,MOTOR BIKES,OTHER ASSETS:

Asset

Value

Bank

Started(m/y)

Original Amountborrowed

Term

Payment

Ballon

CREDITS CARD LIMITS

MONTHLY PAYMENT

BANK

BALANCE

Others :

Others :

Page 5

5. INCOME VS EXPENDITURE CAPACITY

# To work out monthly figures from fortnightly, simply multiply by 26 then divide by 12.
## To work out monthly figures from weekly, simply multiply by 52 then divide by 12.

MONTHLY INCOME

Applicant 1(Net):

Net Income:

$

Pension:

$

Child Care

$

Child Support:

$

Rental:

$

Other:

$

Applicant 2(Net):

Net Income:

$

Pension:

$

Child Care

$

Child Support:

$

Rental:

$

Other:

$

TOTAL INCOME :

$

SURPLUS/DEFECIT :

$

MONTHLY EXPENDITURE

Rent/Board:

$

Food

$

Insurances:

$

Fuel:

$

Entertainment:

$

Electricity:

$

Gas:

$

Phone:

$

Internet:

$

Other:

$

LOANS

Mortgage:

$

Rental Property Loan:

$

Credit Cards:

$

Car Loan1:

$

Car Loan2:

$

Other Loans:

$

This Loan:

$

TOTAL EXPENSES :

$

Page 6

ESTABLISHING CLIENTS’ OBJECTIVES AND BORROWING NEEDS

I/We are not undischarged bankrupt and there are no unsatisfied judgements against me/us.

Yes
No

I/We declare that the name provided above is my/our current true legal name.

Yes
No

I/We declare that the information given in this application is true and correct.

Yes
No

I/We authorise you to contact any person/company to obtain necessary data.

Yes
No

I/We confirm that the income and expenditure detailed above are true and correct, and acknowledge

I/we have the financial capacity to meet the commitments being entered into under this transaction.

Yes
No

What are your expectations for an ideal Credit Representative relationship?

Is there anything in your credit history that would stop you getting a loan?

Yes
No

Are you experiencing financial stress or hardship?

Yes
No

If yes, please explain:

From which lenders have you borrowed money before? How satisfied were you with those products and the lenders?

Additional paymentsWhy is it important to you to make additional payments on your loan?

RateCould you tell me what is important about rate to you?

Pay off quicklyWhy is it important to you to pay off your loan quickly?

How did you come across us ?

Camper Trailer Touring Mag.

Caravan & Motor Home Mag.

Caravan & Motor Home DVD.

Overlander Mag.

Truckin Life Mag.

4WD Action Mag.

4WD Action DVD.

Caravancampingsales.com website.

All 4 Adventure.

Camper Trailer Australia Mag.

Google

Article:

Referral:

Other:

By ticking this box, you acknowledge that you are submitting private information, subject to the Commonwealth Privacy Act, to Fortified Finance & Leasing Pty Ltd. Your information will not be passed on to any lender without your written consent. Financial Services Credit Guide, Client Acknowledgement and Privacy Consent Forms will be emailed to you automatically (to the email address above) once you submit this online application.

Fortified Finance and Leasing are Australia Credit License holders and as such, are qualified to provide you with unbiased, independent advice on seeking loans. You should only be dealing with qualified professionals.